Lung Cancer
Leading cause of cancer death — strongly linked to smoking and increasingly treatable when caught early.
Overview
Lung cancer kills more people than any other cancer in the UK. Non-small cell lung cancer (NSCLC) accounts for ~85% and small cell (SCLC) ~15%. Targeted therapies and immunotherapy have transformed outcomes in advanced NSCLC. The NHS Targeted Lung Health Check programme screens high-risk ever-smokers with low-dose CT.
Symptoms
- • Persistent cough >3 weeks or change in chronic cough
- • Haemoptysis (coughing up blood)
- • Breathlessness or recurrent chest infection
- • Chest or shoulder pain
- • Unexplained weight loss, fatigue, finger clubbing
Risk factors
- • Current or ex-smoker
- • Age >55
- • Occupational exposure
- • COPD, pulmonary fibrosis, previous radiotherapy
Causes
- • Tobacco smoking (~72% of cases)
- • Second-hand smoke, radon exposure, asbestos, diesel fumes
- • Air pollution (PM2.5)
- • Driver mutations: EGFR, ALK, ROS1, KRAS, BRAF, MET (especially never-smokers)
🚨 Red flags — seek urgent care
- • Haemoptysis at any age
- • Persistent cough or chest signs with weight loss
- • Pancoast syndrome: shoulder pain, Horner's, weak hand
- • SVC obstruction: facial swelling, dilated chest veins
When to seek care
- • Any haemoptysis — urgent suspected cancer chest X-ray
- • Cough >3 weeks in ever-smokers >40 — urgent CXR/CT
- • Engage with Targeted Lung Health Check invitations
Diagnosis
- • Chest X-ray then contrast CT chest/abdomen
- • PET-CT for staging if potentially curable
- • Histology: bronchoscopy (EBUS), CT-guided biopsy
- • Molecular profiling: EGFR, ALK, ROS1, BRAF, KRAS, PD-L1 on all NSCLC
- • Brain MRI in stage III/IV NSCLC and all SCLC
Treatment
- • Early NSCLC: lobectomy or stereotactic radiotherapy (SABR); adjuvant chemotherapy/immunotherapy for stage II–III
- • Locally advanced NSCLC: concurrent chemoradiotherapy + durvalumab consolidation
- • Advanced NSCLC: targeted therapy by driver mutation (osimertinib, alectinib), immunotherapy (pembrolizumab) ± chemotherapy
- • SCLC: platinum/etoposide + immunotherapy (atezolizumab/durvalumab); thoracic radiotherapy and PCI in limited stage
- • Palliative care integration from diagnosis improves quality of life and survival
Prevention
- • Stop smoking — single most effective intervention; benefits at any age
- • Reduce radon, asbestos and occupational exposures
- • Engage with targeted lung-health screening (ages 55–74 with smoking history)
Complications
- • Pleural effusion, SVC obstruction, recurrent laryngeal nerve palsy
- • Bone, brain, liver, adrenal metastases
- • Paraneoplastic syndromes: SIADH, Cushing's, Lambert–Eaton
- • Treatment-related: pneumonitis, immune-related adverse events
Prognosis
5-year survival ~60% stage I but <5% stage IV. Early detection via screening can halve mortality in high-risk groups.
Education & self-care
Lung cancer is no longer uniformly fatal. Quitting smoking, attending screening, and acting on persistent cough or bleeding give the best chance of cure.
Frequently asked questions
I have stopped smoking — am I still at risk?
Risk falls steadily after quitting but never quite returns to never-smoker levels. Screening is still worthwhile if eligible.
Can non-smokers get lung cancer?
Yes — about 1 in 7 UK lung cancers occur in never-smokers, often with targetable mutations.
Is a CT scan safe?
Low-dose screening CT uses ~1 mSv, less than annual UK background radiation, and clearly reduces lung cancer mortality.